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Specialty Pharmacy Continuum • May/June 2020
OPERATIONS & MANAGEMENT
Even under the substantial pressures of the ongoing COVID-19 pandemic, patient support programs (PSPs) are making significant progress in ensuring access to affordable, timely clinical care. “We’re personalizing therapy regimens, enhancing telehealth capabilities, and providing far more holistic treatment than we were even three months ago,” said Tommy Bramley, PhD, the president of the Lash Group, an AmerisourceBergen company. “We’re understanding more each day just how interconnected health, social, economic and environmental issues are, and how they’re all impacting patients on an individual level.” Still, challenges remain, Dr. Bramley noted. He cited three main concerns that could prove to be roadblocks to health care delivery and innovation— both during the current pandemic and in the uncertain period that will follow.
1. Patient expectations don’t always match up with reality. Consumers often expect full control over who they do business with and the level of information shared during every experience, Dr. Bramley said. “These principles are now shaping patient mindsets and driving expectations in health care.” The trend has been elevated during COVID-19, he said, with more consumers seeking advice, clinical information, testing and care with heightened urgency. Empowered patients want information at their fingertips. When that information isn’t provided to them proactively, they can turn to online channels such as social media. Although these resources can be good avenues to build community or gain emotional support, Dr. Bramley said, they can present challenges for providers. Patients may not understand that their experience with a particular therapy depends on multiple factors, including their age and clinical profile. As patient expectations continue to evolve, he said, “we must adapt patient support services in real time to complement ... growing [patient] empowerment.”
2. Advancements in services don’t always match up with advancements in science. Manufacturers continue to develop complex new therapies, and some patient populations are getting healthier and living longer as a result, Dr. Bramley said. However, some parts of the system lag behind. For example, patients with chronic conditions often need to interact with multiple providers, including primary care physicians, specialists and
behavioral health providers, which can result in health records and data being scattered across sites of care. “To set patients up for success, we must ensure the services and systems we operate within are continuously advancing and innovating at the same rate as science, while still preserving privacy,” he said. PSPs are using tools such as electronic benefit verification and electronic prior authorization, he noted, so now is the time to think of what’s next, such as potential solutions and processes to alleviate barriers for more complex therapies.
3. Hype surrounding technology doesn’t always match up with thoughtful implementation strategies. Technology has dominated health care investments in recent years, Dr. Bramley said, with all players in the industry facing pressure to implement the latest investments. But in the quest for great technology solutions, don’t forget the “ultimate beneficiaries of our investments: patients,” he said. “The goal of technology should not necessarily be to get things done solely through technology but to improve the patient experience throughout the care journey.” Before adding new technology to workflows, he said, consider what value it will bring to patients, what roadblocks to anticipate, and what is required from the rest of the health care system to work effectively. Don’t let hype overshadow utility. “Technology must be leveraged and monitored by experts who can translate data into personalized clinical interventions infused with empathy and human connectivity,” Dr. Bramley said. “By pairing modern technology with regular clinician engagement, we can reach patients on multiple levels to encourage continued adherence.”
Patient Portals Can Help Certain technologies are trending to help enhance the PSP patient experience, which can be extra helpful during the pandemic, said Jon Kwiatkowski, RPh, the director of pharmacy services for Cardinal Health Sonexus Access and Patient Support. Online enrollment portals enable physicians to go online, do a benefit investigation for their patients, and determine whether patients are eligible for commercial PSPs. If they are,
Prescription abandonment, %
Patient Support Programs Adapt With COVID-19 80 70 Actual data
60
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50 40 30 20 10 0 0
$100
$200
$300
$400
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Out-of-pocket costs
Figure. Prescription abandonment increases 0.6% for each out-of-pocket dollar. Source: Covermymeds (bit.ly/2Wlilfi)
physicians can send all information and a prescription directly; if not, they can send patients to the manufacturer’s hub services team to collect any paperwork needed for such programs. Many state boards of pharmacy are moving to mandated electronic prescriptions, Mr. Kwiatkowski told Specialty Pharmacy Continuum, and this allows for submission of the prescription and support program application together more easily.
Real-Time Benefit Checks PSPs also are employing benefit source portals—tools that allow PSPs to perform real-time benefit check (RTBC) verification for patients, individually or in large batches. RTBCs can be a big time-saver during reenrollment time, he said, where instead of spending a 90-day period calling insurers to determine eligibility criteria, they can run a batch of thousands of patients in a day or so. Such technologies help streamline a process that formerly would have required patients to print something out and take it to their doctor to sign, Mr. Kwiatkowski said. These developments enhance the speed to get patients on their therapies and reenrolled in subsequent years. Managed care experts point to another value of RTBCs: The technology is a valuable tool to lower the cost of prescriptions for patients. That’s a critical benefit, given the strong link between out-of-pocket prescription costs and rates of prescription abandonment (Figure). HealthPartners in Minnesota, part of the largest consumer governed nonprofit health care organization in the United States, jumped on the RTBC bandwagon in 2019, and its initial successes show the power of the patient support tool. The goal, according to Lindsey Colbert, RN, the program manager of care
team efficiency at HealthPartners, was to ensure patients leave the doctor with a prescription they can afford, so they don’t become one of the millions of Americans who are nonadherent because of cost. In June 2018, HealthPartners rolled out a “soft live” and data validation phase at two clinics, in which they asked clinicians to run as many medications as possible through the system and called pharmacies to check on the accuracy of the returned pricing. The reaction was mixed: Clinicians were sometimes hesitant to quote pricing to patients, and formulary alternatives didn’t consistently display. But Ms. Colbert and her colleague, Leann McDowell, ßPharmD, the supervisor of pharmacy utilization management at HealthPartners, heard enough positive stories— such as a patient with diabetes whose monthly cost for one prescription went from $200 to $15 after her doctor ran drugs through the RTBC system—that they decided to roll it out further. More than 66% of queries involving insurance plans administered by HealthPartners via its expanded RTBC initiative returned information about alternative, often lower-priced medications, as previously reported in Specialty Pharmacy Continuum (bit.ly/2YTCQl9). When clinicians receive alternatives, Dr. McDowell said, approximately 30% change the prescription. “So we are seeing some positive change.” —Karen Blum and Alison McCook Dr. Bramley’s comments were culled from presentation materials he was scheduled to present at Informa Connect’s Patient Assistance and Access Programs 2020 conference in March, which was postponed until August because of COVID-19. The Lash Group provided the materials to Specialty Pharmacy Continuum. Mr. Bramley and Mr. Kwiatkowski reported no relevant financial relationships other than their stated employment.
